Thursday, August 27, 2009

A Cartoon on Health Care

7 Comments:

Freemarket said...

What is interesting about this video is that most of the services it cites as government successes (police, fire, education, etc.) are run by local governments, not the federal monstrosity that would be running a single payer health care system. I am always down on local governments but, as bad as they are, I will say that they are light years ahead of the feds in terms of efficiency. I cannot think of single federal government program that can be said to be a model of efficiency, yet this video suggests that a single payer system will financed by doing away with rhetorical bogeymen like “corporate profits” and “executive compensation”. I think that’s a pretty naïve argument to make for a single payer system.

FM, why do a number of other industrialized countries with universal health care such as Canada and Denmark have lower prescription costs, lower overall costs, lower infant mortality rates, and longer life spans? Why when a reporter went looking for the most efficient heath care system was the VA found to be the winner based on hundreds of metrics? Add Phillip Longman's "Best Care Anywhere" and Howard Dean's "Prescription for Real Healthcare Reform" to your reading list.

Many of the countries with universal health care have long waiting lists for services. If you are not allocating care based on price, you naturally have to allocate it based on something else, like time. It’s not uncommon for those folks to come to the USA to get treatment if they need it quickly. With respect to lower infant mortality rates, it’s all in how you cook the statistics. Many foreign countries don’t consider a birth valid until the child lives for a couple of days. Obviously that’s not the case in the USA so it’s not an apples to apples comparison.

If I get some time, I’ll check out those books you mention. I'm no expert on health care, but I am very skeptical that even more government intervention will make things better.

Thanks for the link. I have not read the whole thing yet, but I did scan some interesting things. Certain sections of the report that you posted a link to are a powerful argument against the single payer system promoted by the video Evan has posted. A single payer system is supposedly financed by removing administrative waste, corporate profits and executive compensation from the private sector. Yet dig this on page 130 of the .pdf:

“Ministries of health in low and middle income countries have a reputation for beingamong the most bureaucratic and least effectively managed institutions in the public sector. Designed and initiated in the early 20th century and given wide responsibility for financing and operating extensive public hospital and primary care systems in the post-war period, they became large centralized and hierarchical public bureaucracies, with cumbersome and detailed administrative rules and a permanent staff with secure civil service protections. The ministries were fragmented by many vertical programmes which were often run as virtual fiefdoms, dependent on uncertain international donor funding” (4). The problems described above are familiar, in greater or lesser degree, in many countries today. The consequences are easy to see, but it is not always easy to see why the problems occur or how to solve them. Often that is because the stewards of health suffer specific visual impairments.”

Context is certainly important. Notice the low- and middle-income countries provided as examples immediately thereafter are Myanmar, Nigeria, Viet Nam, and India: countries at economic levels substantially less than the U.S. and other industrialized G20 countries. That subsequent section also mentions the "visual impairment" metaphor they're applying to health care systems in the U.S. and Europe isn't the bureaucracy or effective management of these G20 countries' public health care systems themselves, but rather these richer countries' public health care systems' need to apply even greater oversight of their respective private sector portions of health care delivery and taking a more active role in prevention and inspection of food delivery and occupational safety.

And those less-economically advantaged countries' systems that were designed in the early 20th century are a stark contrast from the VA's system which had a major overhaul in the '90's, among other things now taking great advantage of efficiencies and intelligence of electronic medical records, provisioning, and procurement. Again, see Longman's book on the VA.